A retrospective chart analysis by Madhavan et al. was performed for ten patients who had presented with lumbar discitis and osteomyeli­tis. They all had undergone debridement via the direct lateral retroperitoneal approach. The infection involved one disc and the adjacent vertebral body in nine cases (L2–3 in fi ve cases, L3–4 in three cases, and L1–2 in one case), while one case involved two levels (L3–4 and L4–5). Structural iliac crest autograft bone was used for anterior column reconstruction in nine cases except in one patient with a large bony defect, in whom a titanium mesh cage with morselized autograft iliac crest was used. Eight patients underwent posterior pedicle screw instrumentation, two patients did not undergo posterior instrumentation, and one of these developed a kyphotic deformity that received a secondary posterior procedure. Average follow-up was 680 days. Infection was eradicated in all patients according to a history, physical examination, imaging studies, and laboratory parameters. One patient devel­oped a painful neuroma at the iliac crest har­vest site and one patient with a retroperitoneal hematoma. There were no approach- related neurological injuries or postoperative surgical site infection. The direct lateral approach for the surgical treatment of lumbar discitis and osteomyelitis allows for thorough debridement and spinal reconstruction without the need to mobilize the great vessels, which was consid­ered as an alternative to the open anterior approach. The authors also recommend poste­rior instrumentation to prevent the develop­ment of kyphosis.

sick at the same time without night sweat. The antipyretics could relieve the symptoms to some extent. No signifi cant abnormity was found in the physical examination except ten­derness and percussion pain on the L2–3 spinal process and decreased range of motion. The pain score was shown as follows: VAS for back­aches was 7 points while 0 for leg pain, 28 % for ODI, and18 for JOA, respectively. The patient presented with repeated fever with body temperature fl uctuation in 38–39 °C. The blood samples revealed leukocytosis with an elevated blood sedimentation rate, as well as the C-reactive protein. Considering the possibility of spinal pyogenic infection, we treated with levofl oxacin, which worked soon after prescrip­tion. The surgery was performed after the con­dition that temperature returning to normal. Firstly, we debrided paravertebral abscess, the disc space, and adjacent vertebral bodies of L2–3 via lateral lumbar retroperitoneal approach. Then the cages were inserted into the diseased disc space followed by lateral fi xation through the same approach. Streptococci was found in the culture of the focus and the pathol­ogy report supported the diagnosis of purulent infl ammation. With the 4-week intravenous antibiotics followed by subsequently 6-week oral antibiotics, the patient recovered well. VAS score of low-back pain decreased to 1 point, while no leg pain was reported. Blood samples revealed no abnormity when he discharged from hospital (Fig. 23.1 ).